Environmental sustainability of diets among children and adolescents in the German DONALD cohort study: age and time trends, and nutrient adequacy.

BACKGROUND: Identifying diets beneficial for both human and planetary health has become increasingly important. However, to date, there is limited research on sustainable diets for children and adolescents, a vulnerable population group with specific nutritional needs. OBJECTIVES: We aimed to identify 1) the main determinants; 2) age and time trends of greenhouse gas emissions (GHGE), land use (LU), and water use (WU) of diets of children and adolescents; and 3) analyze the associations of dietary GHGE, LU, and WU with nutrient adequacy. METHODS: A total of 5510 3-d-weighted dietary records (n = 856; 6-17 y; 48% ♀) of the DONALD (DOrtmund Nutritional and Anthropometric Longitudinally Designed) study between 2000 and 2021 were analyzed. Values of GHGE (kgCO2eq), LU (m2 × year), and WU (L) determined by life cycle assessment were assigned to all recorded foods. For nutrient adequacy, the mean adequacy ratio (MAR = ∑(nutrient intake / recommended intake) / number of nutrients) was used. Data were analyzed using polynomial mixed-effects regression models. RESULTS: The main contributors to GHGE and LU were meat products (GHGE: 25.6%; LU: 32.8%), dairy products (22.2%; 17.7%), and sweets and pastries (14.0%; 14.3%); to WU, nonalcoholic beverages (24.3%), meat products (18.9%), and vegetables and fruits (17.7%). GHGE, LU, and WU per 1000 kcal increased with age (P < 0.01). GHGE and LU per 1000 kcal increased between 2000 and 2010 and decreased after that in females (P < 0.01) and males (GHGE only: P = 0.02). No significant time trend was found for WU (P > 0.05). A higher MAR was directly associated with GHGE/1000 kcal (MAR: ß: 0.011, 95% CI: 0.008, 0.013, P < 0.0001), LU/1000 kcal (MAR: ß: 0.009, 95%CI: 0.005, 0.013, P < 0.0001), and WU/1000 kcal (MAR: ß: 0.429, 95% CI: 0.325, 0.533, P < 0.0001). CONCLUSIONS: Our findings underscore the further need and the capacity for change toward more environmentally sustainable diets. Yet, the tradeoff between environmental sustainability and nutrient adequacy in the diets of children and adolescents requires specific attention to dietary composition.

The association between dairy intake in adolescents on inflammation and risk markers of type 2 diabetes during young adulthood: results of the DONALD study.

OBJECTIVE: The aim of this analysis was to investigate whether habitual intake of total dairy (TD) or different dairy types (liquid, solid, fermented, non-fermented, low-fat, high-fat, low-sugar and high-sugar dairy) during adolescence is associated with biomarkers of low-grade inflammation as well as risk factors of type 2 diabetes in young adulthood. DESIGN: Multivariable linear regression analyses were used to investigate prospective associations between estimated TD intake as well as intake of different types of dairy and a pro-inflammatory score, based on high-sensitivity C-reactive protein, IL-6, IL-18, leptin and adiponectin, and insulin resistance assessed as Homeostasis Model Assessment Insulin Resistance in an open-cohort study. SETTING: Dortmund, Germany. PARTICIPANTS: Data from participants (n 375) of the DOrtmund Nutritional and Anthropometric Longitudinally Designed (DONALD) study were included, for whom at least two 3-d weighed dietary records during adolescence (median age: 11 years) and one blood sample in young adulthood (>18 years) were available. RESULTS: There was no statistically significant association between TD intake or intake of any dairy type and the pro-inflammatory score (all P > 0·05). TD intake as well as each dairy type intake and insulin resistance also showed no association (all P > 0·05). CONCLUSIONS: The habitual intake of dairy or individual types of dairy during adolescence does not seem to have a major impact on low-grade systemic inflammation and insulin resistance in the long term. There was no indication regarding a restriction of dairy intake for healthy children and adolescents in terms of diabetes risk reduction.

Cohort profile update-overview of over 35 years of research in the Dortmund Nutritional and Anthropometric Longitudinally Designed (DONALD) study.

PURPOSE: To provide an update on the cohort profile of the DOrtmund Nutritional and Anthropometric Longitudinally Designed (DONALD) study, including objectives, study design, methods and description of the comprehensive data pool, as well as to summarize the most important research findings of recent years. METHODS: In 1985, the open (dynamic) cohort started to collect information on diet, growth, development, and metabolism of healthy children and adolescents in Dortmund, Germany. Detailed data are collected annually during infancy, childhood, and adolescence of the participants, including a 3-day weighed dietary record, a 24-h urine sample, anthropometric and medical examinations as well as interviews on lifestyle. RESULTS: Even if the basic examination modules have not changed since the start over 35 years ago, the DONALD study has been continuously further developed by introducing new modules. As such, participants are also invited for follow-up examinations during adulthood since 2005, including an additional fasting blood withdrawal. Overall, 2375 (♂: 1177; ♀: 1198) participants were recruited in the DONALD study between 1985 and 2022. Data from ~ 30,700 anthropometric measurements, ~ 19,200 dietary records, ~ 10,600 24-h urine and ~ 1300 blood samples are available from an observation period of over 35 years. CONCLUSION: The DONALD study provides a large data pool for longitudinal studies on nutrition, growth, and health in childhood and adolescence, its impact on the development of diseases in early adult life as well as dietary intake trends over more than three decades.

Chronic disease outcome metadata from German observational studies - public availability and FAIR principles.

Metadata from epidemiological studies, including chronic disease outcome metadata (CDOM), are important to be findable to allow interpretability and reusability. We propose a comprehensive metadata schema and used it to assess public availability and findability of CDOM from German population-based observational studies participating in the consortium National Research Data Infrastructure for Personal Health Data (NFDI4Health). Additionally, principal investigators from the included studies completed a checklist evaluating consistency with FAIR principles (Findability, Accessibility, Interoperability, Reusability) within their studies. Overall, six of sixteen studies had complete publicly available CDOM. The most frequent CDOM source was scientific publications and the most frequently missing metadata were availability of codes of the International Classification of Diseases, Tenth Revision (ICD-10). Principal investigators' main perceived barriers for consistency with FAIR principles were limited human and financial resources. Our results reveal that CDOM from German population-based studies have incomplete availability and limited findability. There is a need to make CDOM publicly available in searchable platforms or metadata catalogues to improve their FAIRness, which requires human and financial resources.

Chronobiological changes due to school closures during the COVID-19 pandemic among adolescents in the DOrtmund Nutritional and Anthropometric Longitudinally Designed cohort study.

Due to the lockdown of schools as one of the COVID-19 control measures, adolescents have had the opportunity to re-organise their daily lives; e.g. some of them have adapted their bedtimes to the new situation during the lockdown in favour of their own chronotype. Hence, we investigated differences in chronobiological characteristics (e.g., the midpoint of sleep, sleep duration or social jetlag (SJL); i.e., a discrepancy between biological and social timing) before and during the pandemic lockdown to examine potential changes. We asked participants from the ongoing open cohort Dortmund Nutritional and Anthropometric Longitudinally Designed (DONALD) study to fill out the Munich Chronotype Questionnaire during the COVID-19 lockdown and received the information of participants (n = 66) during the pandemic. A reference group matched for age, season, and sex was randomly selected from the DONALD study to assess participants' chronobiological characteristics prior to (n = 132) the pandemic. Analyses of covariance were applied to examine differences between the two groups reflecting the situation before and during the COVID-19 pandemic. Participants were aged 9-18 years (52% males). In the current examination, average sleep duration across the week was higher among adolescents during the pandemic (ß = 00:30; p = 0.0006) and social jetlag was significantly lower (ß = -00:39; p < 0.0001). CONCLUSION: Our results showed that the COVID-19 lockdown enabled adolescents to adapt their sleeping habits according to their naturally late chronotype, which led to a significant reduction in SJL. These observations are likely to be explained by the effect of school closure. WHAT IS KNOWN: • Under 'normal conditions' without pandemic lockdowns, adolescents accumulate a lack of sleep due to social obligations such as school starts, resulting in social jetlag. • A late chronotype or exposure to social jetlag is a known risk factor for the development of chronic diseases. WHAT IS NEW: • The COVID-19 lockdown represents a 'natural experiment' that enables adolescents to adhere to their internal biological clock. Without the usual social obligations, social jetlag can be significantly reduced.

A healthy lifestyle during adolescence was inversely associated with fatty liver indices in early adulthood: findings from the DONALD cohort study.

A healthy lifestyle during adolescence is associated with insulin sensitivity or liver enzyme levels and thus might contribute to the prevention of non-alcoholic fatty liver disease (NAFLD). Therefore, we examined the association between adherence to a hypothesis-based lifestyle score including dietary intake, physical activity, sedentary behaviour, sleep duration and BMI in adolescence and fatty liver indices in early adulthood. Overall, 240 participants of the DOrtmund Nutritional and Anthropometric Longitudinally Designed study completed repeated measurements of lifestyle score factors during adolescence (females: 8·5-15·5 years, males: 9·5-16·5 years). Multivariable linear regression models were used to investigate the association between adolescent lifestyle scores and NAFLD risk (hepatic steatosis index (HSI) and fatty liver index (FLI)) in early adulthood (18-30 years). Participants visited the study centre 4·9 times during adolescence and achieved on average 2·8 (min: 0·6, max: 5) out of five lifestyle score points. Inverse associations were observed between the lifestyle score and fatty liver indices (HSI: ß=-5·8 % (95 % CI -8·3, -3·1), P < 0·0001, FLI: ß=-32·4 % (95 % CI -42·9, -20·0), P < 0·0001) in the overall study population. Sex-stratified analysis confirmed these results in men, while inverse but non-significant associations were observed in women (P > 0·05). A higher lifestyle score was associated with lower HSI and FLI values, suggesting that a healthy lifestyle during adolescence might contribute to NAFLD prevention, predominantly in men. Our findings on repeatedly measured lifestyle scores in adolescents and their association with NAFLD risk in early adulthood warrant confirmation in larger study populations.

Place of Residence Is Associated with Dietary Intake and BMI-SDS in Children and Adolescents: Findings from the DONALD Cohort Study.

We aimed to determine whether place of residence in the German urban food environment is associated with habitual dietary intake (energy, macronutrients, and food groups) and body mass index (standard deviation score of BMI and BMI-SDS). Our hypothesis was that place of residence may explain some variation in dietary intake and nutritional outcomes. For the cross-sectional analyses of DONALD study data, we grouped participants according to their geocoded residence in the north or south of Dortmund. We applied robust multi-level mixed effects regression models using residence as a predictor and (1) BMI-SDS or (2) dietary data (daily intake of energy (kcal), macronutrients (energy percentage), or food groups (g/1000 kcal)) as the outcome. Models were adjusted for age, sex, and household socio-economic status. An analysis was carried out on 1267 anthropometric measurements collected annually from 360 participants aged 6-18 years (935 3-day weighed dietary records from 292 participants) between 2014 and 2019. In the fully adjusted models, residence in the south was associated with a lower BMI-SDS (ß = -0.42, p = 0.02), lower intake of sugar-sweetened beverages (ß = -47.00, p = 0.04), and higher intake of vegetables (ß = 11.13, p = 0.04). Findings suggest that the place of residence, beyond individuals' socio-economic statuses, may be a contributing factor to dietary quality.

Changes in Total Energy, Nutrients and Food Group Intake among Children and Adolescents during the COVID-19 Pandemic-Results of the DONALD Study.

The COVID-19 pandemic may have changed the habitual lifestyles of children and adolescents, in particular, due to the closure of kindergartens and schools. To investigate the impact of the pandemic on nutrients and food intake of children and adolescents in Germany, we analyzed repeated 3-day weighed dietary records from 108 participants (3-18 years; females: n = 45, males: n = 63) of the Dortmund Nutritional and Anthropometric Longitudinally Designed (DONALD) study. Polynomial mixed-effects regression models were used to identify prospective changes in dietary intake (total energy (TEI), carbohydrates, fat, protein, free sugar, ultra-processed foods, fruits and vegetables, sugar sweetened beverages and juices) before and during the first months of the COVID-19 pandemic. For the current analysis, we have chosen the first months of the pandemic (March 2020-August 2020), as this was the period with the most restrictions in Germany so far (kindergarten, school and restaurant closures; contact and outdoor activity restrictions). No significant changes in either the selected nutrients or food groups were observed. However, children and adolescents recorded a significantly lower TEI during the pandemic (ß = -109.65, p = 0.0062). Results remained significant after the exclusion of participants with under-reported records (ß = -95.77, p = 0.0063). While macronutrient intake did not change, descriptive data indicate a non-significant decrease in sugar sweetened beverages and ultra-processed foods intake. We suggest that children and adolescents from high socioeconomic families may have adapted lifestyle changes during the pandemic.

Dairy intake and long-term body weight status in German children and adolescents: results from the DONALD study.

PURPOSE: To analyse the association between intake of total dairy (TD) and types of dairy [liquid dairy (LD), solid dairy (SD), low-fat dairy (LFD), high-fat dairy (HFD), high sugar dairy (HSD), low-sugar dairy (LSD), not fermented dairy (NFD), as well as fermented dairy (FD)] and long-term changes in body weight status and composition among children and adolescents in Germany. METHODS: In total, 9999 3-day dietary records collected between 1985 and 2019 by 1126 participants (3.5-18.5 years; boys: 50.8%) of the Dortmund Nutritional and Anthropometric Longitudinally Designed (DONALD) study were analysed. Polynomial mixed-effects regression models were used to examine whether changes (median follow-up: 9 years) in the intake of TD and dairy types (in 100 g/1000 kcal total energy intake) were associated with changes in body-mass-index-standard-deviation-score (BMI-SDS); fat mass index (FMI); fat-free mass index (FFMI) over time. RESULTS: An individual increase in TD intake was slightly but significantly associated with an increase in BMI-SDS (ß = 0.0092; p = 0.0371), FMI (ß = 0.022; p = 0.0162), and FFMI (ß = 0.0156; p = 0.0417) after adjustment for potential confounder. Analyses for LD (BMI-SDS: ß = 0.0139; p = 0.0052; FMI: ß = 0.0258; p = 0.0125; FFMI: ß = 0.0239; p = 0.0052) and LSD intake (BMI-SDS: ß = 0.0132; p = 0.0041, FMI: ß = 0.02; p = 0.0316, FFMI: ß = 0.0183; p = 0.0189) showed similar results to TD. Both processing method and fat content showed no association with body composition in our analyses. CONCLUSION: Increases in TD, LD, and LSD intake showed small but significant increases in BMI and concomitant increases in fat mass and lean mass. However, the observed changes were too small to expect biological or physiological meaningful effects. Overall, our results showed that policies to promote dairy intake in childhood are to be welcomed, as no negative effects on body composition are expected, while the intake of important nutrients for growth is ensured. The type of dairy does not seem to matter.

Age and time trends of dairy intake among children and adolescents of the DONALD study.

PURPOSE: To describe age and time trends in dietary intake of Total Dairy (TD) (g/1000 kcal Total Energy Intake) and types of dairy (weight percent of total dairy intake, w%TD) represented as Low Fat Dairy (LFD), High Sugar Dairy (HSD), Fermented Dairy (FD) and Liquid Dairy (LD) among children and adolescents in Germany. METHODS: Overall, 10,333 3-day dietary records kept between 1985 and 2019 by 1275 DONALD participants (3.5-18.5 years; boys: 50.8%) were analyzed using polynomial mixed-effects regression models. RESULTS: TD intake decreased with age (♂: linear trend p < 0.0001; ♀: linear and quadratic trend p < 0.0001), whereas FD (♀: linear, quadratic, cubic trend p ≤ 0.02) increased slightly in girls. HSD (♂: linear, quadratic, cubic trend p ≤ 0.004; ♀: linear, quadratic, cubic trend p ≤ 0.005) and LD (linear, quadratic trend p ≤ 0.0002) decreased with age. In terms of time trends, TD intake decreased in the last three decades, especially since 1995 (quadratic trend for ♂ 0.0007 and ♀ p = 0.004). LFD intake increased until 2010 and decreased thereafter (linear, quadratic, cubic trend p < 0.0001). HSD decreased until 1995, then increased until 2010 and decreased again afterwards (♂: linear, quadratic, cubic trend p ≤ 0.001; ♀: linear, quadratic, cubic trend p ≤ 0.003). While FD intake increased linear (in both ♂ and ♀: p < 0.0001), LD intake decreased (linear, quadratic trend p ≤ 0.03). CONCLUSION: Our results showed changes in dairy consumption patterns among children and adolescents over the past three decades, demonstrating a decrease in TD intake with age and time, and a shift from liquid to solid dairy products with a simultaneous increase in fermented dairy products, while LFD and HSD fluctuated over time. Further evaluations will examine the health significance of these consumption patterns.

Relevance of fructose intake in adolescence for fatty liver indices in young adulthood.

PURPOSE: To examine the association between fructose intake in adolescence and fatty liver indices (hepatic steatosis index (HSI), fatty liver index (FLI)) in young adulthood. METHODS: Overall, 246 participants of the Dortmund Nutritional and Anthropometric Longitudinally Designed (DONALD) study who had a fasting blood sample in adulthood (18-36 years), at least two 3-day weighed dietary records for calculating fructose intakes and other fructose-containing sugars (total (TS), free (FS), added sugar (AS)) as well as two complete 24-h urine samples for calculating sugar excretion (fructose excretion (FE), fructose + sucrose excretion (FE + SE)) in adolescence (males: 9.5-16.5 years; females: 8.5-15.5 years) were analysed using multivariable linear regression analyses. RESULTS: On the level of dietary intake, no prospective associations were observed between adolescent fructose intake and both adult fatty liver indices, whereas higher FS intakes were associated with lower levels of HSI (Ptrend = 0.02) and FLI (Ptrend = 0.03). On the urinary excretion level, however, a higher FE (Ptrend = 0.03) and FE + SE (Ptrend = 0.01) in adolescence were prospectively related to higher adult FLI values. No associations were observed between adolescent sugar excretion and adult HSI. CONCLUSION: The present study does not provide unambiguous support for a detrimental impact of adolescent fructose intake on adult liver health. Nonetheless, further examinations estimating exposure by means of urinary excretion as well as dietary intake levels appear warranted.

Sugar intake among German adolescents: trends from 1990 to 2016 based on biomarker excretion in 24-h urine samples.

Trend analyses based on dietary records suggest decreases in the intakes of total sugar (TS), added and free sugar since 2005 among children and adolescents in Germany. In terms of age trends, TS intake decreased with increasing age. However, self-reported sugar intake in epidemiological studies is criticised, as it may be prone to bias due to selective underreporting. Furthermore, adolescents are more susceptible to underreporting than children. We thus analysed time and age trends in urinary fructose excretion (FE), sucrose excretion (SE) and the sum of both (FE + SE) as biomarkers for sugar intake among 8·5-16·5-year-old adolescents. Urinary sugar excretion was measured by UPLC-MS/MS in 997 24-h urine samples collected from 239 boys and 253 girls participating in the Dortmund Nutritional and Anthropometric Longitudinally Designed (DONALD) study cohort between 1990 and 2016. Time and age trends of log-transformed FE, SE and FE + SE were analysed using polynomial mixed-effects regression models. Between 1990 and 2016, FE as well as FE + SE decreased (linear time trend: P = 0·0272 and P < 0·0001, respectively). A minor increase in excretion during adolescence was confined to FE (linear age trend: P = 0·0017). The present 24-h excretion measurements support a previously reported dietary record-based decline in sugar intake since 2005. However, the previously seen dietary record-based decrease in TS from childhood to late adolescence was not confirmed by our biomarker analysis, suggesting a constant sugar intake for the period of adolescence.

The Prospective Association of Dietary Sugar Intake in Adolescence With Risk Markers of Type 2 Diabetes in Young Adulthood.

Purpose: To examine the prospective relevance of dietary sugar intake (based on dietary data as well as urinary excretion data) in adolescent years for insulin sensitivity and biomarkers of inflammation in young adulthood. Methods: Overall 254 participants of the DONALD study who had at least two 3-day weighed dietary records for calculating intakes of fructose, glucose, sucrose, total, free, added sugars, total sugars from sugar-sweetened beverages (SSB), juice, and sweets/sugar or at least two complete 24 h urine samples (n = 221) for calculating sugar excretion (urinary fructose and urinary fructose + sucrose) in adolescence (females: 9-15 years, males: 10-16 years) and a fasting blood sample in adulthood (18-36 years), were included in multivariable linear regression analyses assessing their prospective associations with adult homeostasis model assessment insulin sensitivity (HOMA2-%S) and a pro-inflammatory score (based on CRP, IL-6, IL-18, leptin, chemerin, adiponectin). Results: On the dietary intake level, no prospective associations were observed between adolescent fructose, sucrose, glucose, added, free, total sugar, or total sugar from SSB, juice or sweets/sugar intake and adult HOMA2-%S (p > 0.01). On the urinary level, however, higher excreted fructose levels were associated with improved adult HOMA2-%S (p = 0.008) among females only. No associations were observed between dietary or urinary sugars and the adult pro-inflammatory score (p > 0.01). Conclusion: The present study did not provide support that dietary sugar consumed in adolescence is associated with adult insulin sensitivity. The one potential exception was the moderate dietary consumption of fructose, which showed a beneficial association with adult fasting insulin and insulin sensitivity.

Age and time trends in sugar intake among children and adolescents: results from the DONALD study.

PURPOSE: To describe age and time trends in added sugar, free sugar and total sugar intake among German 3-18-year-olds. METHODS: Overall, 10,761 3-day dietary records kept between 1985 and 2016 by 1312 DONALD participants (660 boys, 652 girls) were analysed (%E) using polynomial mixed-effects regression models. RESULTS: TS intake decreased with age (♂: linear, quadratic and cubic trend all p < 0.0098; ♀: linear trend p < 0.0001). While the oldest children had the lowest FS intake (linear, quadratic trend: p < 0.0001), the youngest children had the lowest AS intake (linear, quadratic trend p < 0.0001, cubic trend p = 0.0004). In terms of time trends, TS (♂: cubic trend p = 0.0052; ♀: quadratic trend p = 0.0608, cubic trend p = 0.0014) and FS (quadratic trend p = 0.0163, cubic trend p < 0.0001) intake increased between 1985 and 2005 and decreased thereafter, most notably since 2010. AS intake decreased between 1985 and 1995, increased slightly until 2005 and decreased thereafter, most notably since 2010 (linear, quadratic, cubic trend p < 0.0001). FS intake exceeded 10%E/day throughout the 30-year study period. CONCLUSION: Our results do not support the common assumptions that sugar intake is on the rise and generally higher among adolescents than among younger children. Of note, TS, AS and FS intakes have decreased in the last decade among all age groups. Nevertheless, FS intake still exceeds the intake level recommended by the WHO.

Time and Age Trends in Free Sugar Intake from Food Groups among Children and Adolescents between 1985 and 2016.

Trend analyses suggest that free sugar (FS) intake-while still exceeding 10%E-has decreased among German children and adolescents since 2005, yet that intakes may shift from sugars naturally occurring in foods to added sugars as children age. Thus, we analysed time and age trends in FS intake (%E) from food groups among 3-18 year-olds (1985-2016) using 10,761 3-day dietary records from 1312 DONALD participants (660 boys, 652 girls) by use of polynomial mixed-effects regression models. Among girls, FS from sugar & sweets decreased from 1985 to 2016 (linear trend p < 0.0001), but not among boys (p > 0.05). In the total sample, FS intake from juices increased until 2000 and decreased since 2005 (linear, quadratic trend p < 0.0001). FS from sugar sweetened beverages (SSB) decreased non-linearly from 1985 to 2016 (girls: linear, quadratic, cubic trend p < 0.0001; boys: linear, quadratic, cubic trend p < 0.02). Younger children consumed more FS from juices than older ones, who had a higher FS intake from SSB. FS intake from sugar & sweets increased until early adolescence and decreased afterwards. Since sugar & sweets represent the main source of FS intake and the source with the least pronounced decline in intake, public health measures should focus on these products.

Effect of Dietary Sugar Intake on Biomarkers of Subclinical Inflammation: A Systematic Review and Meta-Analysis of Intervention Studies.

It has been postulated that dietary sugar consumption contributes to increased inflammatory processes in humans, and that this may be specific to fructose (alone, in sucrose or in high-fructose corn syrup (HFCS)). Therefore, we conducted a meta-analysis and systematic literature review to evaluate the relevance of fructose, sucrose, HFCS, and glucose consumption for systemic levels of biomarkers of subclinical inflammation. MEDLINE, EMBASE, and Cochrane libraries were searched for controlled intervention studies that report the effects of dietary sugar intake on (hs)CRP, IL-6, IL-18, IL-1RA, TNF-α, MCP-1, sICAM-1, sE-selectin, or adiponectin. Included studies were conducted on adults or adolescents with ≥20 participants and ≥2 weeks duration. Thirteen studies investigating 1141 participants were included in the meta-analysis. Sufficient studies (≥3) to pool were only available for (hs)CRP. Using a random effects model, pooled effects of the interventions (investigated as mean difference (MD)) revealed no differences in (hs)CRP between fructose intervention and glucose control groups (MD: −0.03 mg/L (95% CI: −0.52, 0.46), I² = 44%). Similarly, no differences were observed between HFCS and sucrose interventions (MD: 0.21 mg/L (−0.11, 0.53), I² = 0%). The quality of evidence was evaluated using Nutrigrade, and was rated low for these two comparisons. The limited evidence available to date does not support the hypothesis that dietary fructose, as found alone or in HFCS, contributes more to subclinical inflammation than other dietary sugars.

In adolescence a higher 'eveningness in energy intake' is associated with higher total daily energy intake.

The present manuscript addressed two hypotheses: (i) As children age, energy intake is shifted from morning (energy intake <11am) to evening hours (energy intake >6pm) (ii) A higher 'eveningness in energy intake' (i.e. evening minus morning energy intake) is associated with a higher total daily energy intake. Data were analyzed from 262 DONALD cohort study participants, who had completed at least one 3-day weighed dietary record in the age groups 3/4, 5/6, 7/8, 9/10, 11/12, 13/14, 15/16 and 17/18 years (y). 'Eveningness in energy intake' was compared across age groups and related to total daily energy intake for each age group (multiple cross-sectional analyses). 'Eveningness' increased progressively from age group 3/4y to age group 17/18y. A median surplus of evening energy intake (i.e. when evening intake exceeded morning intake) was firstly observed for age group 11/12y. From age group 11/12y onwards, a higher 'eveningness' was associated with a higher total daily energy intake (all p < 0.04). Difference in total daily energy intake between the highest and the lowest tertile of 'eveningness' was largest for age group 17/18y, amounting to an 11% higher intake among adolescents in the highest as compared to those in the lowest tertile. In conclusion, energy intake progressively shifts from morning to evening hours as children age. Once evening energy intake exceeds morning energy intake, a higher 'eveningness in energy intake' is associated with higher total daily energy intake.